University Medical Leave Request

Vanderbilt University offers leave options to its employees who need to take time off for serious health conditions (for themselves, family members and covered service members), birth or adoption of a child and military exigency. You are in step 1 of the Family Medical Leave Act (FMLA) process (request and eligibility determination). Please complete the information below to submit your request for leave. Our FMLA Coordinator will review your information and determine whether or not you are eligible for FMLA. Eligibility is dependent upon an employee having worked 1250 hours in the last 12 months and having been employed at Vanderbilt for a least one year. You will receive your eligibility determination within 5 working days. If you are eligible for FMLA you will move to step 2 of the FMLA application process. If you have any questions on FMLA, Vanderbilt’s leave policies or this form, please contact The FMLA Processing Team at 615-343-4125.

*Note: Completing this form will also serve as your request for Medical Non-FMLA (if you do not qualify for FMLA). Non-FMLA medical leave may not provide job protection and must be for continuous leave for your own serious health condition (not for your family member).